Schick test | Article about Schick test by The Free Dictionary Schick test | Article about Schick test by The Free Dictionary Schick test, diagnostic test designed to evaluate susceptibility to diphtheria diphtheria , acute contagious disease caused by Corynebacterium diphtheriae (Klebs-Loffler bacillus) bacteria that have been infected by a bacteriophage. It begins as a soreness of the throat with fever. ..... Click the link for more information. . A small amount of diphtheria toxin toxin, poison produced by living organisms. Toxins are classified as either exotoxins or endotoxins. Exotoxins are a diverse group of soluble proteins released into the surrounding tissue by living bacterial cells. Exotoxins have specific reaction sites in the host; e.g. ..... Click the link for more information. is injected into the skin; the injection will produce an area of redness and swelling in individuals with low levels of antibody antibody, protein produced by the immune system (see immunity) in response to the presence in the body of antigens: foreign proteins or polysaccharides such as bacteria, bacterial toxins, viruses, or other cells or proteins. .....

Click the link for more information. (i.e., little immunity immunity, ability of an organism to resist disease by identifying and destroying foreign substances or organisms. Although all animals have some immune capabilities, little is known about nonmammalian immunity. ..... Click the link for more information. ) against the toxin. If the individual is immune to diphtheria, the antibody in the system will neutralize the toxin and no skin reaction will occur. Schick Test a skin test used to determine human susceptibility to diphtheria; one of the allergy-based diagnostic tests, proposed in 1913 by the Austrian pediatrician B. Schick. Dilute active diphtheria toxin is injected into the skin. Local inflammation (reddening, edema) develops three to four days later, and an individual’s reaction is evaluated from the severity of the inflammation. The Schick test is used to determine which individuals, primarily children, should be vaccinated against diphtheria.

Schick test [′shik ‚test] (immunology) A skin test for determining susceptibility to diphtheria performed by the intradermal injection of diluted diphtheria toxin; a positive reaction, showing edema and scaling after 5 to 7 days, indicates lack of immunity. Schick method | Article about Schick method by The Free Dictionary Schick method | Article about Schick method by The Free Dictionary Schick test, diagnostic test designed to evaluate susceptibility to diphtheria diphtheria , acute contagious disease caused by Corynebacterium diphtheriae (Klebs-Loffler bacillus) bacteria that have been infected by a bacteriophage. It begins as a soreness of the throat with fever. ..... Click the link for more information. . A small amount of diphtheria toxin toxin, poison produced by living organisms. Toxins are classified as either exotoxins or endotoxins. Exotoxins are a diverse group of soluble proteins released into the surrounding tissue by living bacterial cells. Exotoxins have specific reaction sites in the host; e.g. ..... Click the link for more information.

is injected into the skin; the injection will produce an area of redness and swelling in individuals with low levels of antibody antibody, protein produced by the immune system (see immunity) in response to the presence in the body of antigens: foreign proteins or polysaccharides such as bacteria, bacterial toxins, viruses, or other cells or proteins. ..... Click the link for more information. (i.e., little immunity immunity, ability of an organism to resist disease by identifying and destroying foreign substances or organisms. Although all animals have some immune capabilities, little is known about nonmammalian immunity. ..... Click the link for more information. ) against the toxin. If the individual is immune to diphtheria, the antibody in the system will neutralize the toxin and no skin reaction will occur. Schick Test a skin test used to determine human susceptibility to diphtheria; one of the allergy-based diagnostic tests, proposed in 1913 by the Austrian pediatrician B. Schick. Dilute active diphtheria toxin is injected into the skin. Local inflammation (reddening, edema) develops three to four days later, and an individual’s reaction is evaluated from the severity of the inflammation.

The Schick test is used to determine which individuals, primarily children, should be vaccinated against diphtheria. Schick test [′shik ‚test] (immunology) A skin test for determining susceptibility to diphtheria performed by the intradermal injection of diluted diphtheria toxin; a positive reaction, showing edema and scaling after 5 to 7 days, indicates lack of immunity. Positive Schick’s test indicates that the person is: A Immune to diphtheria B Hypersensitive to diphtheriaC Susceptible to diphtheriaD Susceptible & hypersensitive to diphtheria - Flash cards Diseases & National Health Programs - Dr. Bhatia Medical Coaching Institute Pvt. Ltd. - Dr Bhatia Medical Coaching Institute Chronic carrier state is seen in all except A TyphoidB Measles C Hepatitis BD Gonorrhea 28) Which of the following is the least common complication of measles?

(AIPG 11) A DiarrheaB Pneumonia C Otitis mediaD SSPE 29) True about endemic typhus is: A Man is the only reservoir B Flea is the vector C Associated with eschar D Culture is diagnostic 30) Not true about lepromin test is A Helps in classification of leprosy B Negative is most of the child in 1st 6 month of life.

C It is a diagnostic test D BCG vaccination may convert lepra reaction into positive 31) In HIV window period indicates:A Time period between infection and onset of first symptomsB Time period between infection and detection of antibodies against HIVC Time period between infection and maximum multiplication of the organismD None of the above 32) Regarding National Polio Surveillance all are true except: (DNB June 09)A Mopping up is done in areas with active cases foundB OPV is given to all children less than five years of age.C Confirmation of diagnosis is by stool sampleD Acute Flaccid Paralysis(AFP) Surveillance is not done in children < 5years of age 33) True about polioviruses is: A Most cases are symptomatic B Inactivated vaccines given I.M.

produce spastic paralysisC Man is the only known reservoir of infectionD Inactivated polio vaccine are given to child less than 3 years of age 34) Positive Schick’s test indicates that the person is: A Immune to diphtheria B Hypersensitive to diphtheriaC Susceptible to diphtheriaD Susceptible & hypersensitive to diphtheria 35) Which of the following diseases is known as the barometer of social welfare? (AIIMS Nov 09) A TBB Malaria C LeprosyD Cholera 36) What is the most important risk factor for becoming a chronic carrier following an acute episode of hepatitis B? A AgeB Gender C Antigen doseD Percutaneous injury 37) Many professional organization recommend that all pregnant women be routinely counseled about HIV infection and be encouraged to be tested. What is the most important reason for early identification of HIV infection in pregnant women? A A cesarean section can be planned to reduced HIV transmission to the newborn.

B Breast feeding can be discouraged to reduce transmission to the new born C Early identification of a new born at risk of HIV infection will improve survival D Zidovudine therapy can be offered to reduce the chance of transmission of HIV to the newborn 38) Varicella is most closely associated with: A A high case fatality rate B Congenital malformations in 30 percent of offspring of infected mothers C A high reinfection rate D Reye syndrome 39) World was declared free of small pox by WHO in: A 1977B 1989 C 1980D 1985 55) Plague epidemic in Surat in 1995 has occurred after a 'silence period' of: (AIIMS Nov 10) A 18 yearsB 28 years C 20 yearsD 30 years 56) Which of the following is best method for prevention of guinea worm disease: A Active search for new cases B Use of cotton cloth to filter the water C Use of mosquito repellents D Chlorination of water 57) According to WHO, the oral rehydration solution (ORS) besides glucose 2

0g/lit.

and sodium; chloride 3.5g/lit, also contains: A 3.5g calcium chloride and 2.5 g potassium chloride B 2.9 g sodium hydroxide and 1.5g sodium acetate C 2.5 g sodium bicarbonate and 1.5g potassium chloride D 1 g potassium hydroxide and 1.5g potassium chloride 58) Which of the following is not true about chickenpox: (AIPG 12) A Centripetal rash B Deep seated multilocular vesicle C Pleomorphic rash D Scab is not infective 59) Mass treatment is given in trachoma if prevalence of moderate and severe trachoma in children below 10 years of age is more than: (AIIMS Nov 09) A 1%B 5% C 10%D 25% 60) Which of the following is known as Fifth disease is: A Erythema infectiosumB Rubeolla infantum C Dukes diseaseD Measles 61) First line of drug for falciparum malaria is(ACT) A ChloroquineB Primaquine C Quinine

D Tetracycline 65) Recommended adult prophylaxis for meningococcal infection is; A Rifampicin 600 mg twice daily for 2 days B Ampicillin Ig daily for 5 days C Tetracycline 2 g daily for 1 day D Chloramphenicol 2 g daily for 2 days 66) Diphtheria most commonly affects children between the age group of: A 6 months to 1 yearB 1 to 5 years C 10-12 yearsD 12 to 14 years 67) In lepromin test, Mitsuda reaction is read after: A 4 weeksB 48 hours C 24 hoursD 8 weeks 68) Which of the following is true regarding Varicella-zoster virus infection: (AIPG 11) A Rash has centrifugal distribution B Incubation period is of 30-100 days C Secondary attack rate is about 50% D Scabes are not infectious 69) Burden of tuberculosis in a community is indicated by: (DNB June 10) A Sputum examination B Tuberculin

 conversion rate C Incidence of new cases D Prevalence of infection 70) In India the natural reservoir of plague is: A Mus maskinaB Rattus rattus C Rattus novergicusD Tetera indica 71) In which of the following form of leprosy, lepromin test is highly positive: (AIIMS May 11) A Borderline typeB Typical tuberculoid C LepromatousD Intermediate 72) Which of the following is true regarding infectivity of whooping cough: A Patient is infectious before the onset of whoop B Patient is infectious 10 days before whoop C Patient is infectious for entire duration of illness D Patient is infectious 10 days before and after the onset of whoop 73) Which of the following is not helpful in preventing dracunculiasis: (AIIMS Nov 12) A Mass mebendazole treatment B Active search for new cases C Education regarding water hygiene D Filtering of drinking water 74) Treatment of a single skin anaesthetic lesion of leprosy found on the forearm is: A Single dose of ROMB WHO PB ROM C WHO MB ROMD None of the above 75)

 In staphylococcal food poisoning signs and symptoms develops in: A 2-6 hoursB 12-14 hours C 24-36 hoursD 48-72 hours 76) Which of the following is not true about polio?

A Type 1 strain is responsible for epidemics of paralytic polio B Type 2 strain is most immunogenic C Transmission is mainly by droplet infection D Man is only reservoir of infection 77) Most common site of hydatid cyst is: A BrainB Liver C LungsD Spleen 88) Which of the following is the investigation of choice of diphtheria carrier? (DNB June 09) A Ziehl-Neelsen stainB Albert stain C Gram's stainD Throat swab culture 89) Which of the following is the infective form of Ancylostoma duodenale?

A Rhabditiform larva after molting twice B Freshly hatched rhabditiform larva C Trophozoites D Cyst 90) Which of the following hepatitis viruses have significant perinatal transmission: A Hepatitis E virusB Hepatitis C virus C Hepatitis B virusD Hepatitis A virus 91) Leprosy is considered a public health problem if the prevalence of leprosy is more than: A 1 per 10,000B 2 per 10,000 C 5 per 10,000D 10 per 10,000 92) For controlling an outbreak of cholera, all of the following measures are recommended except A Mass chemoprophylaxis B Proper disposal of excreta C Chlorination of water D Early detection and management of cases Non Communicable Diseases 93) According to the WHO the STEPS approach is used for surveillance of which of the following?

A Surveillance of risk factors of communicable disease B Surveillance of risk factors of non communicable disease C Surveillance of mortality from communication disease D Surveillance of mortality from non communicable disease 94) STEPS is a technique used in following disease A Risk factor NCD B Amoebic encephalopathy C Cardio vascular diseases D TB 95) Blindness as defined by WHO is the visual acuity of less than: (DNB Dec 11) A 6/18B 6/24 C 6/60D 3/60 96) Which of the following is the infective stage of malarial parasite: A GametocyteB Schizonts C TrophozoitesD Sporozoites 110) Arthropod transmitted disease not found in India? A West nile fever B Dengue C Yellow fever D Japanese Encephalitis 111) Which of the following is not true about Japanese encephalitis? A About 80% of the patients are children below 5 years of age. B In epidemics, cases scatter with no more than 1-2 per village.

C Overt disease to unapparent cases ratio is 1:100. D Bite from infected mosquito always leads to the disease 112) All are non deliberate measures for control of mosquito except? A Use of alkaline soap water in factory B Use of larvicidal agentsC Efforts by community to prevent the development of environment suitable for the mosquitoesD Use of bed nets for mosquito 113) Which of the following transmits scrub typhus: A MiteB Tick C AedesD Anopheles 135) Which of the following is true regarding arboviruses disease?

(AIIMS Nov 09) A Japanese encephalitis is transmitted by Aedes B Tics transmit KFD C Dengue virus has only 1 serotype D Yellow fever is endemic in India 136) Founders of vision 2020 all except A Who B UNICEF C International agency to prevent blindness D Orbis international 137) Goals of national population policy are all except A Bring down TFR to replacement level by 2015 B Reduce MMR to below 100 per 100,000 live births C Achieve 100 per cent registration of births, deaths, marriage & pregnancy D Decrease IMR to below 30 per 1000 live births 138) Which is the most efficacious vaccine?

A MeaslesB DPT C TTD Polio 147) "Impact" indicator for evaluation of ASHA's performance- (AIPG 09) A Number of meetings attended B Number of institutional deliveries C Reduction in infant mortality D Hours of training 148) All are included in NRHM except- A Strengthening of JSY B Formation of patient and social welfare societies C State and district health mission D Recruitment and training of ASHA 149) All are true about Effective leprosy control prog except?

(DNB June 09) A High new case detection rate B Increasing no of children affected C Decreased type 2 disability D Reduction in the default rate 150) For operating the Blood bank license given by: A NACO B NABL C State health ministry/ ministry of health D Drug controller general of INDIA 151) Nobel prize Oct 2007 for medicine was given for :- A Detection of chemical /growth factors for preventing growth of tumors B Principles for introducing specific gene modifications in mice by the use of embryonic stem cells C Non genetic method treating muscular dystrophies D None of the above 152) All of the following are include in NPCB in tenth year plan except: A >80% IOL implantation surgery B 450 million cataract surgery per lac C Vit. A prophylaxis 5 doses starting at 9 month of age till 3 years. D Development of 50 pediatric ophthalmology unit 153) All are targeted in “Target intervention for HIV” except: A Street childrenB Industrial worker C Migrant laborersD Sex workers 154) Which is not included in national population policy?

A To achieve NRR to replacement levels by 2015 B To reduce IMR = 30 C To reduce MMR = 100 D 100% registration of birth, death, pregnancy, and marriage 155) Case finding in RNTCP is based on A Sputum cultureB X-ray chest C Sputum microscopyD Mantoux test 158) Under the National Programme for control of blindness who is supposed to conduct the vision screening of school students?

(AIIMS Nov 09)A School teachers B Medical officers of health centersC Ophthalmologists D Health assistants 159) All of the following are true with regard to Malaria drug policy 2007 except: A ACT is the regimen of choice for chloroquin resistant P.falciparum B Presumptive treatment is indicated for all fever cases C Rapid diagnostic kit is used to confirm the diagnosis of malaria D Quinine is the drug of choice for severe and complicated malaria 160) Which of the following is not a component of enhanced malaria control project A Rapid diagnostic dip stick test for Pf B Permethrin coated bed nets C Microscopy centre for 50,000 rural population D Drug regimen based on artemisinin derivative 161) As per the WHO definition, XDR –TB is defined as A Resistant to at least INH and rifampicin B resistant to fluoroquinolones C resistant to at least to of the inject able drug for TB D all of the above 162) As per the latest RNTCP guidelines history of cough for what duration is required to qualify a patient as a TB suspect?

A 1 weekB 2 weeks C 3 weeksD 4 weeks 163) Which of the following diseases is not included under national vector borne diseases control programme A DengueB Filaria C ChickungunyaD KFD 164) Which of the following drugs is not used in the continuation phase of management of a multi drug resistant TB as per the DOTS Plus regime?

A Ethionamide B Cycloserine C Kanamycin D Ethambutol 165) The vitamin A supplement administered in prevention of nutritional blindness in children programme contains: A 25,000 IU/ml B 1 lakh IU/ml C 3 lakh IU /ml D 5 lakh IU /ml 166) Which of the following is not the activity under revised National Tuberculosis Control Programme A Short course chemotherapy provided free of charge B Involvement of NGOs C Active case finding D Chemotherapy in intensive phase is administered under direct supervision 167) As per WHO, tuberculosis is said to be under control when: A <1 % population is tuberculin positive B <1 % population is sputum positive C >10 % population is sputum positive D < 5% TB cases 168) ICDS was started in: (DNB June 10) A 1968B 1972 C 1975D 1977 170) Which of the following is false regarding baby friendly hospital initiative recommendations: A Mother and infant to remain together 24 hours a day B Exclusive breastfeeding should be promoted till 4-

6 months of age C Mother initiates breastfeeding within 4 hours after normal delivery D Newborn baby should not begin with food or drink 171) As per the latest recommendation for supplementary nutrition under the ICDS scheme, a malnourished child receives the following amount of calories at the AWC: A 500 KcalB 600 Kcal C 800 KcalD 300 Kcal 172) NDPS act true is – A Provides for rehabilitation and treatment of addicts rather than punishment B Provides for punishment of drug addicts and illicit sale of drugs C Both of the above D None 173) Schick method | definition of Schick method by Medical dictionary Schick method | definition of Schick method by Medical dictionary Schick test [shik] intracutaneous injection of diluted diphtheria toxin equal to one-fiftieth of the minimum lethal dose.

Lack of immunity to diphtheria is indicated by redness and edema appearing at the injection site in 24 to 36 hours and lasting four to five days. This test has now largely been replaced by hemagglutination inhibition tests . Schick test (shik), a test for susceptibility to Corynebacterium diphtheriae toxin: 0.1 mL of Schick test toxin is injected into the skin of one forearm (test site) and the same quantity of the same, but heat-inactivated, material into the skin of the other forearm (control site); those with toxin-neutralizing antibodies either will have no reaction at either injection site (negative test) or may have a pseudoreaction due to antibodies for substances (antigens) in the test materials other than diphtheria toxin; people lacking toxin-neutralizing antibodies may have a positive reaction, which consists of an area of redness appearing 24-36 hours at the test site only and persisting for 4-5 days. (shĭk) n. A test to determine immunity to diphtheria by injection into the skin of dilute diphtheria toxin.

Inflammation of the injected area indicates a lack of immunity. Schick test [shik] Etymology: Bela Schick, Austrian-American physician, 1877-1967 a skin test formerly used to determine immunity to diphtheria in which dilute diphtheria toxin is injected intradermally. A positive reaction, indicating susceptibility, is marked by redness and swelling at the site of injection; a negative reaction, indicating immunity, is marked by absence of redness or swelling. Schick test An obsolete test once used to detect immunity to diphtheria toxin, based on response to subcutaneous heat-inactivated toxin. Schick test (shik test) An assessment for susceptibility to Corynebacterium diphtheriae toxin. Schick test toxin is injected into the skin; people lacking toxin-neutralizing antibodies may have a positive reaction, which consists of an area of redness. Schick test A skin test of susceptibility to DIPHTHERIA . (Bela Schick, 1877–1967, Hungarian-born American paediatrician).

Schick, Diphtheria | definition of diphtheria by Medical dictionary Diphtheria | definition of diphtheria by Medical dictionary Definition Diphtheria is a potentially fatal, contagious disease that usually involves the nose, throat, and air passages, but may also infect the skin. Its most striking feature is the formation of a grayish membrane covering the tonsils and upper part of the throat. Description Like many other upper respiratory diseases, diphtheria is most likely to break out during the winter months. At one time it was a major childhood killer, but it is now rare in developed countries because of widespread immunization. Since 1988, all confirmed cases in the United States have involved visitors or immigrants. In countries that do not have routine immunization against this infection, the mortality rate varies from 1.5-25%. Persons who have not been immunized may get diphtheria at any age. The disease is spread most often by droplets from the coughing or sneezing of an infected person or carrier. The incubation period is two to seven days, with an average of three days.

It is vital to seek medical help at once when diphtheria is suspected, because treatment requires emergency measures for adults as well as children. Causes and symptoms The symptoms of diphtheria are caused by toxins produced by the diphtheria bacillus, Corynebacterium diphtheriae (from the Greek for "rubber membrane"). In fact, toxin production is related to infections of the bacillus itself with a particular bacteria virus called a phage (from bacteriophage; a virus that infects bacteria). The intoxication destroys healthy tissue in the upper area of the throat around the tonsils, or in open wounds in the skin. Fluid from the dying cells then coagulates to form the telltale gray or grayish green membrane. Inside the membrane, the bacteria produce an exotoxin, which is a poisonous secretion that causes the life-threatening symptoms of diphtheria. The exotoxin is carried throughout the body in the bloodstream, destroying healthy tissue in other parts of the body. The most serious complications caused by the exotoxin are inflammations of the heart muscle ( myocarditis ) and damage to the nervous system.

The risk of serious complications is increased as the time between onset of symptoms and the administration of antitoxin increases, and as the size of the membrane formed increases. The myocarditis may cause disturbances in the heart rhythm and may culminate in heart failure . The symptoms of nervous system involvement can include seeing double (diplopia), painful or difficult swallowing, and slurred speech or loss of voice, which are all indications of the exotoxin's effect on nerve functions. The exotoxin may also cause severe swelling in the neck ("bull neck"). The signs and symptoms of diphtheria vary according to the location of the infection: Nasal Nasal diphtheria produces few symptoms other than a watery or bloody discharge. On examination, there may be a small visible membrane in the nasal passages. Nasal infection rarely causes complications by itself, but it is a public health problem because it spreads the disease more rapidly than other forms of diphtheria. Pharyngeal Pharyngeal diphtheria gets its name from the pharynx, which is the part of the upper throat that connects the mouth and nasal passages with the voice box.

This is the most common form of diphtheria, causing the characteristic throat membrane. The membrane often bleeds if it is scraped or cut. It is important not to try to remove the membrane because the trauma may increase the body's absorption of the exotoxin. Other signs and symptoms of pharyngeal diphtheria include mild sore throat , fever of 101-102°F (38.3-38.9°C), a rapid pulse, and general body weakness. Laryngeal Laryngeal diphtheria, which involves the voice box or larynx, is the form most likely to produce serious complications. The fever is usually higher in this form of diphtheria (103-104°F or 39.4-40°C) and the patient is very weak. Patients may have a severe cough , have difficulty breathing, or lose their voice completely. The development of a "bull neck" indicates a high level of exotoxin in the bloodstream. Obstruction of the airway may result in respiratory compromise and death .

Skin This form of diphtheria, which is sometimes called cutaneous diphtheria, accounts for about 33% of diphtheria cases. It is found chiefly among people with poor hygiene. Any break in the skin can become infected with diphtheria. The infected tissue develops an ulcerated area and a diphtheria membrane may form over the wound but is not always present. The wound or ulcer is slow to heal and may be numb or insensitive when touched. Diagnosis Because diphtheria must be treated as quickly as possible, doctors usually make the diagnosis on the basis of the visible symptoms without waiting for test results. In making the diagnosis, the doctor examines the patient's eyes, ears, nose, and throat in order to rule out other diseases that may cause fever and sore throat, such as infectious mononucleosis , a sinus infection, or strep throat . The most important single symptom that suggests diphtheria is the membrane. When a patient develops skin infections during an outbreak of diphtheria, the doctor will consider the possibility of cutaneous diphtheria and take a smear to confirm the diagnosis.

Laboratory tests The diagnosis of diphtheria can be confirmed by the results of a culture obtained from the infected area. Material from the swab is put on a microscope slide and stained using a procedure called Gram's stain. The diphtheria bacillus is called Gram-positive because it holds the dye after the slide is rinsed with alcohol. Under the microscope, diphtheria bacilli look like beaded rod-shaped cells, grouped in patterns that resemble Chinese characters. Another laboratory test involves growing the diphtheria bacillus on a special material called Loeffler's medium. Treatment Diphtheria is a serious disease requiring hospital treatment in an intensive care unit if the patient has developed respiratory symptoms. Treatment includes a combination of medications and supportive care: Antitoxin The most important step is prompt administration of diphtheria antitoxin, without waiting for laboratory results. The antitoxin is made from horse serum and works by neutralizing any circulating exotoxin. The doctor must first test the patient for sensitivity to animal serum.

Patients who are sensitive (about 10%) must be desensitized with diluted antitoxin, since the antitoxin is the only specific substance that will counteract diphtheria exotoxin. No human antitoxin is available for the treatment of diphtheria. The dose ranges from 20,000-100,000 units, depending on the severity and length of time of symptoms occurring before treatment. Diphtheria antitoxin is usually given intravenously. Antibiotics Antibiotics are given to wipe out the bacteria, to prevent the spread of the disease, and to protect the patient from developing pneumonia . They are not a substitute for treatment with antitoxin. Both adults and children may be given penicillin, ampicillin, or erythromycin. Erythromycin appears to be more effective than penicillin in treating people who are carriers because of better penetration into the infected area. Cutaneous diphtheria is usually treated by cleansing the wound thoroughly with soap and water, and giving the patient antibiotics for 10 days.

Supportive care Diphtheria patients need bed rest with intensive nursing care, including extra fluids, oxygenation, and monitoring for possible heart problems, airway blockage, or involvement of the nervous system. Patients with laryngeal diphtheria are kept in a croup tent or high-humidity environment; they may also need throat suctioning or emergency surgery if their airway is blocked. Patients recovering from diphtheria should rest at home for a minimum of two to three weeks, especially if they have heart complications. In addition, patients should be immunized against diphtheria after recovery, because having the disease does not always induce antitoxin formation and protect them from reinfection. Prevention of complications Diphtheria patients who develop myocarditis may be treated with oxygen and with medications to prevent irregular heart rhythms. An artificial pacemaker may be needed. Patients with difficulty swallowing can be fed through a tube inserted into the stomach through the nose. Patients who cannot breathe are usually put on mechanical respirators. Prognosis The prognosis depends on the size and location of the membrane and on early treatment with antitoxin; the longer the delay, the higher the death rate.

The most vulnerable patients are children under age 15 and those who develop pneumonia or myocarditis. Nasal and cutaneous diphtheria are rarely fatal. Prevention Antitoxin — An antibody against an exotoxin, usually derived from horse serum. Bacillus — A rod-shaped bacterium, such as the diphtheria bacterium. Carrier — A person who may harbor an organism without symptoms and may transmit it to others. Cutaneous — Located in the skin. Diphtheria-tetanus-pertussis (DTP) — The standard preparation used to immunize children against diphtheria, tetanus, and whooping cough. A so-called "acellular pertussis" vaccine (aP) is usually used since its release in the mid-1990s. Exotoxin — A poisonous secretion produced by bacilli which is carried in the bloodstream to other parts of the body. Gram's stain — A dye staining technique used in laboratory tests to determine the presence and type of bacteria. Loeffler's medium — A special substance used to grow diphtheria bacilli to confirm the diagnosis. Myocarditis — Inflammation of the heart tissue.

Toxoid — A preparation made from inactivated exotoxin, used in immunization. diphtheria [dif-thēr´e-ah] an acute, highly contagious childhood disease that generally affects the membranes of the throat and, less frequently, the nose; in rare instances it can affect other parts of the body, notably the skin, following an open wound. Caused by the bacillus Corynebacterium diphtheriae, it can be fatal if not treated promptly. However, repeated exposure to the causative organisms may provide a natural immunity. adj., adj diphthe´rial, diphther´ic, diphtherit´ic. Diphtheria spreads in droplets of moisture from the mouth, nose, or throat of an infected person. It may also be spread by handkerchiefs, towels, eating utensils, or any other object used by an infected person or sprayed by his coughing or sneezing. It may also be transmitted by a healthy person who is nevertheless a carrier of the disease or by someone who is convalescing from diphtheria. The incubation period of the disease is generally between 2 and 5 days, sometimes longer.

An infected person may continue to have the bacilli in his throat from 2 to 4 weeks after he has recovered from its effects. Symptoms. The first symptoms of diphtheria usually include sore throat, fever, headache, and nausea. Patches of grayish or dirty-yellowish membrane form in the throat, and gradually grow into one membrane. This membrane, combined with swelling of the throat, may interfere with swallowing or breathing. In severe cases, when other measures fail, a tracheostomy may be necessary to restore breathing. The diphtheria bacillus also produces a toxin that spreads throughout the body and may damage the heart and nerves permanently. Diagnosis of the disease can be verified by identifying the causative organisms from throat cultures. Susceptibility to diphtheria is determined by the Schick test. A positive skin test indicates the absence of circulating antibodies to the diphtheria toxin, but a pseudoreaction can also occur. Treatment. Diphtheria antitoxin is administered to counteract the toxic reaction from the bacillus. Prognosis depends on the severity of the infection and especially on how soon the antitoxin is given.

Rest, antibiotics, and general hygienic measures are used to combat the infection. Oxygen is administered as necessary to relieve dyspnea and cyanosis. Cardiac complications are usually more severe in adults; thus the convalescent period is extended for these patients. Prevention. Immunization should be begun between the sixth and eighth weeks of an infant's life. Diphtheria and tetanus toxoids and pertussis vaccine (DTaP) is the preferred vaccine for all doses in the vaccination series. Booster doses are also needed later in life. (See also table under immunization .) Once one of the most fatal diseases of childhood, cases of diphtheria and death from the disease have become almost nonexistent in countries where mass immunization has been practiced. diph·the·ri·a (dif-thēr'ē-ă), Avoid the misspelling/mispronunciation dipheria.

A specific infectious disease due to the bacterium Corynebacterium diphtheriae and its highly potent toxin; marked by severe inflammation that can form a membranous coating, with formation of a thick fibrinous exudate, of the mucous membrane of the pharynx, the nose, and sometimes the tracheobronchial tree; the toxin produces degeneration in peripheral nerves, heart muscle, and other tissues, diphtheria had a high fatality rate, especially in children, but is now rare because of an effective vaccine. [G. diphthera, leather] diphtheria /diph·the·ria/ (dif-thēr´e-ah) an acute infectious disease caused by Corynebacterium diphtheriae and its toxin, affecting the membranes of the nose, throat, or larynx, and marked by formation of a gray-white pseudomembrane, with fever, pain, and, in the laryngeal form, aphonia and respiratory obstruction.

The toxin may also cause myocarditis and neuritis.diphthe´rialdiphther´icdiphtherit´ic diphtheria (dĭf-thîr′ē-ə, dĭp-) n. An acute infectious disease caused by the bacterium Corynebacterium diphtheriae, which infects mucous membranes of the throat, causing formation of a thick layer called the false membrane that can obstruct breathing, and producing a potent toxin that enters the bloodstream and causes systemic effects that include damage to the heart and nervous system. diph′the·rit′ic (-thə-rĭt′ĭk), diph·ther′ic (-thĕr′ĭk), diph·the′ri·al adj. diphtheria [difthir′ē·ə, dipthir′ē·ə] Etymology: Gk, diphthera, leather membrane an acute contagious disease caused by the bacterium Corynebacterium diphtheriae. It is characterized by the production of a systemic toxin and an adherent false membrane lining of the mucous membrane of the throat.

The toxin is particularly damaging to the tissues of the heart and central nervous system, and the dense pseudomembrane in the throat may interfere with eating, drinking, and breathing. The membrane may also be present in other body tissues. Lymph glands in the neck swell, and the neck becomes edematous. Untreated, the disease is often fatal from respiratory obstruction or heart and kidney failure. Patients are usually hospitalized in isolation rooms. Treatment of the isolated patient may include administration of diphtheria antitoxin, antibiotics, bed rest, fluids, and an adequate diet. Tracheostomy is sometimes necessary. Recovery is slow, but it is usually complete. Immunization against diphtheria is available to all children in the United States and is usually given in conjunction with pertussis and tetanus immunization early in infancy. See also Schick test . Diphtheria: false membrane lining diphtheria Diphtheritis Infectious disease An acute, potentially fatal infection, primarily of the upper respiratory tract, throat. See DTP–Diphtheria-Tetanus-Pertussis and DTaP–acellular Pertussis vaccines.

diph·the·ri·a (dif-thēr'ē-ă) A specific infectious disease due to Corynebacterium diphtheriae and its highly potent toxin; marked by severe inflammation with formation of a thick membranous coating of the pharynx, the nose, and sometimes the tracheobronchial tree; the toxin produces degeneration in peripheral nerves, heart muscle, and other tissues. Symptoms include fever, fatigue, sore throat, difficulty in swallowing, and nausea. Adult morbidity ranges from 5-10%; in children younger than 5 years of age, mortality approaches 20%. [G. diphthera, leather] diphtheria A serious, and highly infectious, disease caused by the toxin of an organism Corynebacterium diphtheriae . This normally attacks the throat causing a membrane-like exudate of clotted serum, white cells, bacteria and dead surface tissue cells to form. This may obstruct the upper air passages, necessitating an emergency artificial opening into the windpipe (a tracheostomy) to save life. The bacterial toxin can also affect the heart.

diphtheria a serious disease of the upper respiratory tract in man caused by toxins produced by the bacterium Corynebacterium diphtheriae. The toxins cause NECROSIS of epithelial cells in the throat, resulting in the production of a greyish EXUDATE that gradually forms a membrane on the tonsils and can spread upwards into the nasal passages, or downwards into the larynx causing suffocation if not treated. diphtheria, n communicable disease caused by the bacterium Cornyebacterium diphtheriae, which releases an extremely damaging toxin to the central nervous system and heart. It also produces an adherent pseudo-membrane lining to the throat that may interfere with eating and drinking. Treated by administration of diphtheria antitoxin, antibiotics, rest, and fluids. diph·the·ri·a (dif-thēr'ē-ă) Avoid the misspelling/mispronunciation dipheria. A specific infectious disease due to infection by the bacterium Corynebacterium diphtheriae and its highly potent toxin. [G.

diphthera, leather] Corynebacterium diphtheriae and Diphtheria To search the entire book, enter a term or phrase in the form below Custom Search This chapter has 4 pages © Kenneth Todar, PhD Diphtheria Corynebacterium diphtheriae Corynebacteria are Gram-positive, aerobic, nonmotile, rod-shaped bacteria classified as Actinobacteria. Corynebacteria are related phylogenetically to mycobacteria and actinomycetes. They do not form spores or branch as do the actinomycetes, but they have the characteristic of forming irregular, club-shaped or V-shaped arrangements in normal growth. They undergo snapping movements just after cell division, which brings them into characteristic forms resembling Chinese letters or palisades. The genus Corynebacterium consists of a diverse group of bacteria including animal and plant pathogens, as well as saprophytes. Some corynebacteria are part of the normal flora of humans, finding a suitable niche in virtually every anatomic site, especially the skin and nares.

The best known and most widely studied species is Corynebacterium diphtheriae, the causal agent of the disease diphtheria. Figure 1. Stained Corynebacterium cells. The "barred" appearance is due to the presence of polyphosphate inclusions called metachromatic granules. Note also the characteristic "Chinese-letter" arrangement of cells. Diphtheria is an upper respiratory tract illness characterized by sore throat, low fever, and an adherent membrane (called a pseudomembrane on the tonsils, pharynx, and/or nasal cavity. Diphtheria toxin produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. A milder form of diphtheria can be restricted to the skin. Diphtheria is a contagious disease spread by direct physical contact or breathing aerosolized secretions of infected individuals. Once quite common, diphtheria has largely been eradicated in developed nations through wide-spread use of the DPT vaccine. For example, in the U.S., between 1980 and 2004 there were 57 reported cases of diphtheria.

However, it remains somewhat of a problem worldwide (3,978 reported cases to WHO in 2006) in the face of efforts to achieve global vaccination coverage. Diphtheria is a serious disease, with fatality rates between 5% and 10%. In children under 5 years and adults over 40 years, the fatality rate may be as much as 20%. Outbreaks, although very rare, still occur worldwide, even in developed nations. Following the breakup of the former Soviet Union in the late 1980s, vaccination rates in the constituent countries fell so low that there was a surge in diphtheria cases. In 1991 there were 2,000 cases of diphtheria in the USSR. By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths. Figure 2. This figure shows the reported global incidence of diphtheria between 1980 and 2006.

Generally, as vaccine coverage with DPT has increased, the incidence of diphtheria has decreased. However, note the spike between 1993 and 1997, attributable to a drop in vaccine coverage in new Independent States of the former Soviet Union, as explained in the text above. WHO. History and Background No bacterial disease of humans has been as successfully studied as diphtheria. The etiology, mode of transmission, pathogenic mechanism and molecular basis of exotoxin structure, function, and action have been clearly established. Consequently, highly effective methods of treatment and prevention of diphtheria have been developed. The study of Corynebacterium diphtheriae traces closely the development of medical microbiology, immunology and molecular biology. Many contributions to these fields, as well as to our understanding of host-bacterial interactions, have been made studying diphtheria and the diphtheria toxin. Some of the milestones along this path are given below. Hippocrates provided the first clinical description of diphtheria in the 4th century B.C. There are also references to the disease in ancient Syria and Egypt.

In the 17th century, murderous epidemics of diphtheria swept Europe; in Spain the disease became known as "El garatillo" (the strangler"), in Italy and Sicily as "the gullet disease". In the 18th century, the disease reached the American colonies where it reached epidemic proportions about 1735. Often, whole families died of the disease in a few weeks. The bacterium that causes diphtheria was first described by Klebs in 1883, and was cultivated by Loeffler in 1884, who applied Koch's postulates and properly identified Corynebacterium diphtheriae as the agent of the disease. In 1884, Loeffler concluded that C. diphtheriae produced a soluble toxin, and thereby provided the first description of a bacterial exotoxin. In 1888, Roux and Yersin demonstrated the presence of the toxin in the cell-free culture fluid of C. diphtheriae which, when injected into suitable lab animals, caused the systemic manifestation of diphtheria.

Two years later, von Behring and Kitasato succeeded in immunizing guinea pigs with a heat-attenuated form of the toxin and demonstrated that the sera of immunized animals contained an antitoxin capable of protecting other susceptible animals against the disease. This modified toxin was suitable for immunizing animals to obtain antitoxin, but it was found to cause severe local reactions in humans and could not be used as a vaccine. In 1909, Theobald Smith, in the U.S., demonstrated that diphtheria toxin that had been neutralized by antitoxin (forming a Toxin-Anti-Toxin complex, TAT) remained immunogenic and eliminated local reactions seen in the modified toxin. For some years, beginning about 1910, TAT was used for active immunization against diphtheria. TAT had two undesirable characteristics as a vaccine. First, the toxin used was highly toxic, and the quantity injected could result in a fatal toxemia unless the toxin was fully neutralized by antitoxin. Second, the antitoxin mixture was horse serum, the components of which tended to be allergenic and to sensitize individuals to the serum.

In 1913, Schick designed a skin test as a means of determining susceptibility or immunity to diphtheria in humans. Diphtheria toxin will cause an inflammatory reaction when very small amounts are injected intracutaneously. The Schick Test involves injecting a very small dose of the toxin under the skin of the forearm and evaluating the injection site after 48 hours. A positive test (inflammatory reaction) indicates susceptibility (nonimmunity). A negative test (no reaction) indicates immunity (antibody neutralizes toxin). In 1924, Ramon demonstrated the conversion of diphtheria toxin to its nontoxic, but antigenic, equivalent (toxoid) by treating with formaldehyde. He provided humanity with one of the safest and surest vaccines of all time, the diphtheria toxoid. In 1951, Freeman made the remarkable discovery that pathogenic (toxigenic) strains of C. diphtheriae are lysogenic, (i.e., are infected by a temperate Beta phage), while non lysogenized strains are avirulent.

Subsequently, it was shown that the gene for toxin production is located on the DNA of the Beta phage. In the early 1960s, Pappenheimer and his group at Harvard conducted experiments on the mechanism of a action of the diphtheria toxin. They studied the effects of the toxin in HeLa cell cultures and in cell-free systems, and concluded that the toxin inhibited protein synthesis by blocking the transfer of amino acids from tRNA to the growing polypeptide chain on the ribosome. They found that this action of the toxin could be neutralized by prior treatment with diphtheria antitoxin. Subsequently, the exact mechanism of action of the toxin was shown, and the toxin has become a classic model of an ADP-ribosylating bacterial exotoxin. Diphtheria in the United States At the turn of the century, in the United States, diphtheria was common, occurring primarily in children and was one of the leading causes of death in infants and children. In the l920's, when data were first gathered, there were approximately 150,000 cases and 13,000 deaths reported annually.

After diphtheria immunization was introduced, the number of cases gradually fell to about 19,000 in 1945. When diphtheria immunization became widespread in the late 1940's, a more rapid decrease in the number of cases and deaths occurred. From 1970 to 1979, an average of 196 cases per year were reported. Seventeen outbreaks of 15 or more cases occurred in the United States between 1959 and 1980, but there have been none since 1980. During 1980-1995, a total of 41 respiratory diphtheria cases were reported; of these, four (10%) were fatal, and all occurred in unvaccinated children. Since 1988 Five of the six culture-positive diphtheria cases reported in the United States have been associated with importation of Corynebacterium diphtheriae, an organism believed to have become rare or to have disappeared from the United States. However, a case of infection with toxigenic C.

diphtheriae discovered in 1996 showed that the bacterium remains present in areas where the disease was once endemic, such as the Northern Plains Indian Community of South Dakota. On June 1, 1996, the discovery of a 62-year-old American Indian woman infected with diphtheria led to increased surveillance of the disease among the community. C. diphtheriae was isolated in 5% of 133 patients surveyed during August-October 1996. The findings underline the need for timely vaccination by people of all ages throughout the US. Schick reaction - definition of Schick reaction by The Free Dictionary Schick reaction - definition of Schick reaction by The Free Dictionary (shĭk) n. A test to determine immunity to diphtheria by injection into the skin of dilute diphtheria toxin. Inflammation of the injected area indicates a lack of immunity.

[After Béla Schick (1877-1967), Hungarian-born American pediatrician.] Schick test (ʃɪk) n (Medicine) med a skin test to determine immunity to diphtheria: a dilute diphtheria toxin is injected into the skin; within two or three days a red inflamed area will develop if no antibodies are present [C20: named after Bela Schick (1877–1967), US paediatrician] Schick′ test` a diphtheria immunity test in which diphtheria toxoid is injected intracutaneously, nonimmunity being indicated by an inflammation at the injection site. [1915–20; after B. Schick ] ThesaurusAntonymsRelated WordsSynonymsLegend:

Question: The Schick Test indicates susceptibility or immunity to which disease?
Answer: Diphtheria